Vendor Onboarding Form

VENDOR ONBOARDING FORM

Company Legal Name:   DBA / Trade Name:

Company Details

Years in Business:   State of Formation:

Corporation    LLC    Sole Proprietor    Partnership    Government    Other:

Tax and Payment Information

ACH / Electronic Transfer    Check    Credit Card

Insurance & Compliance

Does your organization maintain required insurance coverage as applicable to services provided?   General Liability    Professional Liability (E&O)    Workers' Compensation

Position & Engagement Information

Reporting Manager (client contact):   Planned Start Date:

Employment History (Contact Person)

Dates Employed: From to

Dates Employed: From to

Education

Graduation Date:   Major / Field:

Professional References

Legal Disclosures & Certifications

At-Will Employment Statement: The company and any person provided by the vendor may be considered independent contractors; nothing in this onboarding form alters the at-will nature of any employment relationship between the company and its employees. Vendor acknowledges that vendor personnel are not employees of the company and that the company is not liable for vendor payroll, taxes, or benefits unless expressly agreed in a separate written agreement.

Equal Opportunity Statement: Vendor certifies that it does not discriminate in employment or contracting on the basis of race, color, religion, sex, national origin, age, disability, or any other protected characteristic and agrees to comply with applicable equal opportunity laws in performance of services.

Background Checks and References: Vendor authorizes the company and its authorized agents to contact listed references and prior employers and to conduct background investigations, including criminal history and credit checks where permitted by law, for the purpose of assessing vendor fitness to perform services. By checking the box below, vendor provides express written consent:    I consent to background and reference checks.

I certify under penalty of perjury that the information provided in this form is true, complete, and correct to the best of my knowledge. I acknowledge that providing false information may result in rejection of this onboarding request or termination of any existing relationship and that the company may pursue all available legal remedies.

Vendor authorizes the company to share vendor contact information and contract-relevant details with internal business units and third-party service providers solely for purposes of procurement, compliance review, payment processing, and performance monitoring. Vendor will promptly notify the company in writing of any material changes to the information provided.

Vendor will maintain administrative, physical, and technical safeguards appropriate to the sensitivity of company data and will not disclose confidential information except as permitted under a separate confidentiality agreement. Vendor agrees to notify the company of any unauthorized disclosure or breach of company data within 72 hours of discovery.

Vendor agrees to defend, indemnify, and hold harmless the company, its officers, directors, and employees from and against any and all claims, liabilities, losses, damages, costs, and expenses (including reasonable attorneys' fees) arising out of vendor's performance, negligence, willful misconduct, or breach of this form or applicable law.

The company reserves the right to suspend or terminate any engagement with vendor for cause or for convenience upon written notice. Termination shall not relieve vendor of obligations incurred prior to the termination date, including but not limited to duties of confidentiality and indemnification.

Additional Disclosures

Is the vendor, any owner, or principal currently debarred, suspended, or otherwise ineligible to provide goods or services to any government or private sector entity?    No    Yes — If yes, provide details below.

Please indicate any small business or diversity certifications held (check all that apply):
Small Business    Minority-Owned    Women-Owned    Veteran-Owned

Applicant Certification & Authorization

I certify that, to the best of my knowledge, all information contained in this Vendor Onboarding Form is true, complete and accurate. I acknowledge and agree that the company may rely on these representations in approving vendor status and processing payments. I further authorize the company to contact any third parties necessary to verify the information provided, to obtain references, and to perform background checks as permitted by law.

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